JACKSON-WALNUT PARK SCHOOLS APPLICATION
PHONE: 617-202-9772
FAX: 617-415-1630
EMAIL: ADMISSIONS@JACKSONWALNUTPARKSCHOOLS.ORG
APPLICATION DEADLINE: FEBRUARY 12, 2016
STUDENT INFORMATION
School:  Jackson School
 Walnut Park Montessori
Name:
First
Middle
Preferred Name:
Last
Date of Birth (mm/dd/yyyy):
Year of Enrollment:
Age:
Gender: Male / Female
Home Address:
City:
State/Country:
Zip:
Will you be applying for financial aid:  Yes /  No
Home Phone:
U.S. Citizen/Permanent Resident:  Yes /  No
Child resides with: Both Parents / Mother / Father / Guardian / Other:
* Optional Questions
*Ethnicity:
*Religion or Place of Worship:
For Jackson School Applicants:
Grade Entering:
Present School:
Present School City:
For Walnut Park Montessori School Applicants:
Program Desired:  Primary  Toddler
Toddler Schedule: 2 / 3 / 5 Days per week
Previous Montessori Experience:
PARENT/GUARDIAN 1 INFORMATION
Parent 1 is:  Mother  Father  Grandparent  Other
Full Name:
Address (skip if same as above):
City:
State:
Zip:
Home Phone:
Cell Phone:
Email:
Work Phone:
Work Email:
Employer:
Position or Title:
College(s) Attended, Degree(s) and Year(s):
PARENT/GUARDIAN 2 INFORMATION
Parent 2 is:  Mother  Father  Grandparent  Other
Full Name:
Address (skip if same as above):
City:
State:
Zip:
Home Phone:
Cell Phone:
Email:
Work Phone:
Work Email:
Employer:
Position or Title:
College(s) Attended, Degree(s) and Year(s):
ADDITIONAL INFORMATION
Place of birth:
Language(s) spoken at home:
Do you have any additional information that you would like to share about your child’s needs as a learner?
What qualities about JWP Schools make you believe it would be a good fit for your child?
How did you hear about JWP Schools? Please list any advertisements:
INFORMATION ON OTHER CHILDREN
Name(s)
Date of Birth
Current School
Grade
SEASONAL ADDRESS (if different from primary address)
 Please send publications to this address
Date from:
Date to:
Address:
Phone:
PARENTAL EXPERTISE, INTERESTS AND AFFILIATIONS
Your experience with other organizations may be of help to Jackson-Walnut Park. Please list educational, cultural, community
organizations or volunteer leadership positions with which you are active and please describe any areas of expertise or
interests that might benefit our community. You may attach additional sheets, if necessary.
Name of Parent / Guardian:
Affiliations / Interests / Expertise:
APPLICATION FEE
Please enclose a non-refundable $55 application fee payable ($250 for international applicants seeking an F-1
Visa) to Jackson-Walnut Park Schools.
Mailing Address:
Jackson-Walnut Park Admissions
71 Walnut Park
Newton, MA 02458
Jackson-Walnut Park admits students of any race, color, religion, ethnic or national origin to all rights, privileges, programs and activities
generally accorded or made available to students at the schools. Jackson-Walnut Park Schools does not discriminate on the basis of race,
color, religion, ethnic or national origin in the administration of educational policies, admissions policies, financial assistance programs or in
the hiring of school personnel. We respect the confidentiality of all information. The information provided will be used solely for
school purposes.
JWP STAFF USE ONLY
Date Received:
Check Number:
Staff Initials: